PM&DC should look at the end product, ensure quality of care rather than placing too much emphasis on infrastructure

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Restructuring of the PM&DC
PM&DC should look at the end product,
ensure quality of care rather than placing
too much emphasis on infrastructure
Professional specialty organizations can start Re-
certification of their members but this committee should
consist of honest individuals known for their intellectual integrity

LAHORE: An informal discussion on structure, functioning and responsibilities of Pakistan Medical & Dental Council was also held during the International Conference on General Medical Updates at Fatima Memorial Hospital on February 27th 2019. Dr. Ghulam Rasool Mufti lead the discussion which was also participated by other invited guest speakers from UK and USA which included Dr. Shaukat Ashai, Dr.Noor Ali Pirzada, Dr. Farhat Ashai Khan, Dr. Nuzhat Ashai, Dr. Arjmand Mufti while Prof. Rakhshanda Rehman, Prof. Nighat Mir and Mrs. Shahima Rehman represented the FMH. During the discussion it was emphasized that PM&DC should include some representatives from the Civil Society like eduatioists or those representing Trusts working in the health sector. It must look at the end product i.e. quality of doctors and the quality of care being provided at the healthcare facilities rather than giving too much emphasis on number of faculty members and other infrastructure.

In Pakistan it was also pointed out that too many organizations, institutions are trying to regulate the profession and medical institutions’. There is a need to start re-certification and re-validation of healthcare professionals. The emphasis by the regulators is on space, buildings, equipment, infrastructure and the number of faculty members rather than on the end product. In this whole process the emphasis on the end product is lost. Before taking decisions it is essential to involve the stake holders. It was also felt that while private medical institutions’ were being regulated more strictly, deficiencies in the public sector institutions is often ignored and over-looked. Prof. Nighat Mir pointed out that while speaking in the provincial assembly recently Prof. Yasmin Rashid the provincial health minister had stated that over four thousand posts were lying vacant in public sector institutions. Dr. Shaukat remarked that these days there is more emphasis on Out Patients treatment, community care and Day Care surgery and reducing the period of hospitalization. More research is being done which procedure reduces the patient’s hospital stay and thus results in cost curtailment.

Healthcare professionals as well as the healthcare providers need to be regulated. The objective should be to ensure production of safe doctors. PM&DC can look after registration which also needs to be decentralized and done by the provinces while some other institution, organization can take care of revalidation. Prof. Nighat Mir suggested that it can be entrusted to CPSP which has a good set up with regional centers all over the country. They can create a specific department for this. However, it was also suggested that let the professional specialty organizations do this re-validation. They can monitor and re-validate their own members to begin with. However, it must be ensured that the committee looking after re-certification or re-validation consists of honest professionals who are known for their professional integrity. This is feasible and practical and can be started without much struggle. Self assessment, peer review and the importance of regular academic audit was also emphasized.

Dr. Ghulam Rasool Mufti opined that it must be ensured that the system is not over regulated. One can start with just simple evaluation and revalidation after every two years. He suggested that a committee should come up with a working paper entitled “Agenda for a change”. It should identify the problems, discuss with colleagues and then take on board all the stake holders. Ask them that these are the problems and let us come up with some solutions. This working paper can then result in a proper document for a change which can be shared with all the medical colleges and then finally presented to the government authorities. During the discussion it was also highlighted that while in United States there is too much emphasis on Knowledge and Skills, in United Kingdom there is emphasis on everything and quality of care in particular. In UK there is too much emphasis on reducing the number of days in the hospitals. One can reserve half a day to discuss issues confronted and try to learn from the mistakes. All the ADRs should be documented. In UK the Care Quality Commission takes care of all these things and everything is documented. These reports are not shared with the public but the Courts can have access to all this. Participants agreed that Clinical Audit helps a great deal in improving the quality of care being provided at the healthcare facilities.

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